Is aortography abused in lower-limb iscaemia?

Request for aortography on 82 patients in one hospital in 1978 were assessed to determine the effect of the investigation on the patient's subsequent management. In 49% of cases the request was fully justified. In the remaining 51% of patients, none of whom had reconstructive surgery, the request was considered either inappropriate (38%) or of marginal value (13%). The reasons for this high porportion of unnecessary aortograms were related to the clinical specialty and the level of experience of the doctor making the request. A simple algorithm which may be helpful when deciding to perform an aortogram is suggested. It is concluded that aortography should be requested only by experienced medical staff and only after a decision has been taken to offer the patient operative treatment.